Cost-Effectiveness of FDG-PET/CT for Cytologically Indeterminate Thyroid Nodules: A Decision Analytic Approach

Autor: L.F. de Geus-Oei, Jan W. A. Smit, Dennis Vriens, Wim J.G. Oyen, J.H.W. de Wilt, Eddy M. M. Adang, Romana T. Netea-Maier
Přispěvatelé: Biomedical Photonic Imaging, Faculty of Science and Technology
Rok vydání: 2014
Předmět:
Adult
Thyroid nodules
medicine.medical_specialty
Cost effectiveness
Cost-Benefit Analysis
Endocrinology
Diabetes and Metabolism
Clinical Biochemistry
Unnecessary Surgery
Rare cancers Radboud Institute for Molecular Life Sciences [Radboudumc 9]
Multimodal Imaging
Sensitivity and Specificity
Biochemistry
Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18]
Decision Support Techniques
Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14]
Endocrinology
Fluorodeoxyglucose F18
Cytology
Humans
Medicine
In patient
Thyroid Neoplasms
Thyroid Nodule
business.industry
Decision Trees
Biochemistry (medical)
Health Care Costs
medicine.disease
Markov Chains
Women's cancers Radboud Institute for Health Sciences [Radboudumc 17]
Aspiration cytology
Positron-Emission Tomography
Fdg pet ct
Radiology
Radiopharmaceuticals
Tomography
X-Ray Computed
business
Indeterminate
Models
Econometric
Zdroj: Journal of clinical endocrinology and metabolism, 99(9), 3263-3274. Oxford University Press
Journal of Clinical Endocrinology and Metabolism, 99, 3263-74
Journal of Clinical Endocrinology and Metabolism, 99, 9, pp. 3263-74
ISSN: 1945-7197
0021-972X
DOI: 10.1210/jc.2013-3483
Popis: Contains fulltext : 137703pub.pdf (Publisher’s version ) (Open Access) Contains fulltext : 137703pos.pdf (Author’s version postprint ) (Open Access) CONTEXT: Patients with thyroid nodules of indeterminate cytology undergo diagnostic surgery according to current guidelines. In 75% of patients, the nodule is benign. In these patients, surgery was unnecessary and unbeneficial because complications may occur. Preoperative fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) was found to have a very high negative predictive value (96%) and might therefore avoid futile surgery, complications, and costs. In the United States, two molecular tests of cytology material are routinely used for this purpose. OBJECTIVE: Five-year cost-effectiveness for routine implementation of FDG-PET/CT was evaluated in adult patients with indeterminate fine-needle aspiration cytology and compared with surgery in all patients and both molecular tests. DESIGN: A Markov decision model was developed to synthesize the evidence on cost-effectiveness about the four alternative strategies. The model was probabilistically analyzed. One-way sensitivity analyses of deterministic input variables likely to influence outcome were performed. SETTING AND SUBJECTS: The model was representative for adult patients with cytologically indeterminate thyroid nodules. MAIN OUTCOME MEASURES: The discounted incremental net monetary benefit (iNMB), the efficiency decision rule containing outcomes as quality-adjusted life-years and (direct) medical cost, of implementation of FDG-PET/CT is displayed. RESULTS: Full implementation of FDG-PET/CT resulted in 40% surgery for benign nodules, compared with 75% in the conventional approach, without a difference in recurrence free and overall survival. The FDG-PET/CT modality is the more efficient technology, with a mean iNMB of euro3684 compared with surgery in all. Also, compared with a gene expression classifier test and a molecular marker panel, the mean iNMB of FDG-PET/CT was euro1030 and euro3851, respectively, and consequently the more efficient alternative. CONCLUSION: Full implementation of preoperative FDG-PET/CT in patients with indeterminate thyroid nodules could prevent up to 47% of current unnecessary surgery leading to lower costs and a modest increase of health-related quality of life. Compared with an approach with diagnostic surgery in all patients and both molecular tests, it is the least expensive alternative with similar effectiveness as the gene-expression classifier.
Databáze: OpenAIRE
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